Correlation between In Vivo and In Vitro Efficacy of Antimicrobial Agents against Foreign Body Infections

Widmer, Andreas F.; Frei, Reno; Rajacic, Zarko; Zimmerli, Werner

doi:10.1093/infdis/162.1.96

Cited by 295 publications

(209 citation statements)

References 27 publications

(30 reference statements)

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“…Failure of therapy was observed for two patients who had delayed infection and for whom antimicrobial treatment was considered inappropriate. The excellent success rate in our study (82%) confirms data from in vitro and animal experiments [3,4,7,8]. A recent study showed that a cure rate of 90% can be achieved with combination therapy with ofloxacin and rifampin [9].…”

supporting

confidence: 85%

“…New antimicrobial regimens may cure infections that were previously considered as necessitating removal of the device [2]. We previously observed in an animal model that even short-term treatment with rifampin can sterilize implant-related infections due to Staphylococcus epidermidis and Staphylococcus aureus [3][4][5]. The present trial was designed as a pilot study for evaluating whether a rifampin-containing regimen could cure ODRIs rather than only suppress the clinical symptoms.…”

mentioning

confidence: 99%

“…Laboratory findings indicating cure were defined as an erythrocyte sedimentation rate of <30 mm/h or a C-reactive protein concentration of <20 mg/ L and a white blood count of <10,000/mm 3 . Endpoints of the study were defined as follows.…”

mentioning

confidence: 99%

“…Furthermore, this therapy does not preclude regular treatment, including removal of the device if treatment with rifampin combinations fail. On the basis of these clinical results and the encouraging data from in vitro tests and animal experiments [3][4][5], a multicenter, double-blind controlled clinical trial comparing regular antimicrobial treatment with and without rifampin was launched in January 1992. However, with the low incidence of such infections and the required follow-up, the results of the study will not be published before 1996.…”

mentioning

confidence: 99%

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Antimicrobial Treatment of Orthopedic Implant-related Infections with Rifampin Combinations

Widmer¹,

Gaêchter²,

Ochsner³

et al. 1992

Clinical Infectious Diseases

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235

144

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The purpose of this prospective clinical study is to evaluate the role of combination chemotherapy with rifampin in the treatment of orthopedic device-related infections in which the implant could not be removed. Eleven patients with orthopedic implant-related infections due to staphylococci or streptococci were treated with the implant in situ. Each antimicrobial regimen included rifampin in combination with a 19-lactam antibiotic or ciprofloxacin. The median duration of treatment with rifampin was 86 days (range, 15-336 days) with a median follow-up of >24 months after cessation of therapy. Treatment was successful for 82% of patients. Failures were associated with documented inappropriate treatment. These preliminary clinical data are supported by data from in vitro studies and animal experiments. Combination therapy with rifampin, in particular rifampin and a quinolone, should be considered for patients with orthopedic implant-related infections if the implant cannot be removed.Long-term intravenous therapy combined with a one-or two-stage replacement is frequently necessary for controlling orthopedic device-related infection (ODRI) [1]. New antimicrobial regimens may cure infections that were previously considered as necessitating removal of the device [2]. We previously observed in an animal model that even short-term treatment with rifampin can sterilize implant-related infections due to Staphylococcus epidermidis and Staphylococcus aureus [3][4][5]. The present trial was designed as a pilot study for evaluating whether a rifampin-containing regimen could cure ODRIs rather than only suppress the clinical symptoms. We applied such a regimen to 11 patients who had ODRIs and from whom the device could not be removed.We prospectively observed 11 patients (five women and six men) with ODRIs due to gram-positive cocci who were consulted by physicians from the Division of Infectious Diseases (A

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supporting

confidence: 85%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Antimicrobial Treatment of Orthopedic Implant-related Infections with Rifampin Combinations

Widmer¹,

Gaêchter²,

Ochsner³

et al. 1992

Clinical Infectious Diseases

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235

144

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“…For optimal eradication of SCVs, treatment should consist of therapy with an antibiotic that has optimal bactericidal activity against slowly growing bacteria (Vaudaux et al 2006). Rifampin may be the most efficient antibiotic because of its excellent efficacy against stationary and adherent bacteria (Widmer et al 1990). Although rifampin has very good bactericidal activity against slow-growing bacteria, it should be given in combination with other antibiotics because of the rapid emergence of resistance when given alone (Vaudaux et al 2006).…”

Section: Antibiotic Resistancementioning

confidence: 99%

The role of small-colony variants in failure to diagnose and treat biofilm infections in orthopedics

et al. 2007

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Adjunctive Use of Rifampin for the Treatment of Staphylococcus aureus Infections

Perlroth

Kuo²,

Tan³

et al. 2008

Arch Intern Med

202

129

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Background: Staphylococcus aureus causes severe lifethreatening infections and has become increasingly common, particularly methicillin-resistant strains. Rifampin is often used as adjunctive therapy to treat S aureus infections, but there have been no systematic investigations examining the usefulness of such an approach. Methods: A systematic review of the literature to identify in vitro, animal, and human investigations that compared single antibiotics alone and in combination with rifampin therapy against S aureus.Results: The methods of in vitro studies varied substantially among investigations. The effect of rifampin therapy was often inconsistent, it did not necessarily correlate with in vivo investigations, and findings seemed heavily dependent on the method used. In addition, the quality of data reporting in these investigations was often suboptimal. Animal studies tended to show a microbiologic ben-efit of adjunctive rifampin use, particularly in osteomyelitis and infected foreign body infection models; however, many studies failed to show a benefit of adjunctive therapy. Few human studies have addressed the role of adjunctive rifampin therapy. Adjunctive therapy seems most promising for the treatment of osteomyelitis and prosthetic device-related infections, although studies were typically underpowered and benefits were not always seen. Conclusions:In vitro results of interactions between rifampin and other antibiotics are method dependent and often do not correlate with in vivo findings. Adjunctive rifampin use seems promising in the treatment of clinical hardware infections or osteomyelitis, but more definitive data are lacking. Given the increasing incidence of S aureus infections, further adequately powered investigations are needed.

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Correlation between In Vivo and In Vitro Efficacy of Antimicrobial Agents against Foreign Body Infections

Cited by 295 publications

References 27 publications

Antimicrobial Treatment of Orthopedic Implant-related Infections with Rifampin Combinations

Antimicrobial Treatment of Orthopedic Implant-related Infections with Rifampin Combinations

The role of small-colony variants in failure to diagnose and treat biofilm infections in orthopedics

Adjunctive Use of Rifampin for the Treatment of Staphylococcus aureus Infections

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